Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $90.07 / $90.07 / $94.58	Facility	26	$90.07	$90.07	$94.58
Aetna Facility/Professional Professional Modifier Low / Median / High Price $146.47 / $174.95 / $255.42	Professional		$146.47	$174.95	$255.42
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $51.30 / $72.63 / $212.85	Professional	26	$51.30	$72.63	$212.85
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $75.92 / $99.40 / $138.63	Professional	TC	$75.92	$99.40	$138.63
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $95.50 / $102.84 / $123.51	Professional		$95.50	$102.84	$123.51
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $55.77 / $78.84 / $130.62	Professional	26	$55.77	$78.84	$130.62
BCBS Facility/Professional Professional Modifier Low / Median / High Price $89.94 / $150.58 / $209.37	Professional		$89.94	$150.58	$209.37
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $93.26 / $109.72 / $109.72	Professional	26	$93.26	$109.72	$109.72
CareSource Facility/Professional Professional Modifier Low / Median / High Price $56.28 / $84.94 / $156.68	Professional		$56.28	$84.94	$156.68
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $79.31 / $79.31 / $79.31	Facility	26	$79.31	$79.31	$79.31
Cigna Facility/Professional Professional Modifier Low / Median / High Price $109.44 / $206.23 / $371.41	Professional		$109.44	$206.23	$371.41
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $49.82 / $77.72 / $152.21	Professional	26	$49.82	$77.72	$152.21
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $55.67 / $109.93 / $294.89	Professional	TC	$55.67	$109.93	$294.89
Health Alliance Plan Facility/Professional Facility Modifier 26 Low / Median / High Price $43.92 / $90.07 / $113.50	Facility	26	$43.92	$90.07	$113.50
Health Alliance Plan Facility/Professional Professional Modifier Low / Median / High Price $115.31 / $171.00 / $255.42	Professional		$115.31	$171.00	$255.42
Health Alliance Plan Facility/Professional Professional Modifier 26 Low / Median / High Price $43.92 / $77.38 / $212.85	Professional	26	$43.92	$77.38	$212.85
Health Alliance Plan Facility/Professional Professional Modifier TC Low / Median / High Price $67.28 / $86.76 / $132.00	Professional	TC	$67.28	$86.76	$132.00
Molina Facility/Professional Professional Modifier Low / Median / High Price $56.47 / $86.81 / $156.75	Professional		$56.47	$86.81	$156.75
United Facility/Professional Professional Modifier Low / Median / High Price $131.53 / $166.57 / $277.68	Professional		$131.53	$166.57	$277.68
United Facility/Professional Professional Modifier 26 Low / Median / High Price $53.79 / $68.77 / $94.56	Professional	26	$53.79	$68.77	$94.56
United Facility/Professional Professional Modifier TC Low / Median / High Price $69.39 / $92.76 / $209.29	Professional	TC	$69.39	$92.76	$209.29